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首页> 外文期刊>感染症学雑誌 >A case of Munchausen syndrome with recurrent bacteremia and PR3-ANCA positivity
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A case of Munchausen syndrome with recurrent bacteremia and PR3-ANCA positivity

机译：Munchausen综合征，复发性菌血症和PR3-ANCA阳性

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A 29-year-old woman chiropractor with repeated episodes of bacteremia and positive for cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and antiproteinase-3 (PR3) antibody had an 11-year history of asthma and repeated hospitalization. While hospitalized she developed a spiking nocturnal fever with chills and erythema of the lower leg. Her fever resolved spontaneously, but corticosteroid therapy and antibiotics did not effectively reduce her symptoms. Plain X-ray film and CT showed pulmonary changes, and lung biopsy granulomas without vasculitis. Immunological studies showed a positive PR3-ANCA (c-ANCA) test, and skin biopsy of the crural erythema showed foreign body granuloma. Multiple blood cultures were positive for several strains of bacteria, including Fusobacterium necrophurum, Mycobacterium fortuitum, and Clostridium species. When placed in a single room and monitored, she did not develop new fever or erythema. Because self-injury was assumed, she was diagnosed as having Munchausen syndrome. This is, to our knowledge, the first report of Munchausen syndrome with PR3-ANCA positivity. In patients with repeated infections, the possibility of self-injury, the development of PR3-ANCA positivity, and pulmonary granuloma with a disease profile similar to vasculitis syndrome should be considered in the definitive diagnosis.
机译：一名29岁的女性脊医，其反复发生菌血症，且胞浆抗中性粒细胞胞浆抗体（c-ANCA）和抗蛋白酶3（PR3）抗体阳性，有11年的哮喘病史，并曾多次住院治疗。住院期间，她出现了夜间发烧，小腿发冷和红斑。她的发烧自发地消退，但是皮质类固醇激素疗法和抗生素并未有效减轻她的症状。 X线平片和CT均显示肺部改变，肺活检肉芽肿无血管炎。免疫学研究显示PR3-ANCA（c-ANCA）测试呈阳性，并且皮肤的红斑活检显示异物肉芽肿。多种血液培养对几种细菌菌株均呈阳性，包括坏死镰刀菌，Fortuitum分枝杆菌和梭状芽孢杆菌。当放在一个房间里进行监视时，她没有发烧或出现红斑。因为假定自己受伤，所以她被诊断患有Munchausen综合征。据我们所知，这是Munchausen综合征PR3-ANCA阳性的首例报告。对于反复感染的患者，在明确诊断中应考虑自身伤害的可能性，PR3-ANCA阳性的发展以及疾病特征类似于血管炎综合征的肺肉芽肿。

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